Dialysis is a medical procedure that functions as external life support, taking over the work of failing kidneys to filter waste and fluid from the blood. For individuals with end-stage kidney disease, this treatment is a necessary replacement for the body’s natural filtration system. When a person chooses to stop receiving dialysis, they are electing to allow the underlying kidney failure to take its natural, fatal course. The cessation of treatment results in the rapid and unchecked accumulation of toxic byproducts and excess fluids within the body’s systems, leading to death within a matter of days or weeks.
How the Body Reacts to Cessation
The kidneys perform three main functions: filtering toxins, balancing electrolytes, and managing fluid volume, all of which cease to be regulated after dialysis is stopped. Without the regular cleansing of the blood, nitrogenous waste products like urea quickly build up, a condition known as uremia. This toxic environment affects nearly every organ system, particularly the brain, leading to a progressive and profound decline in neurological function.
Another immediate and life-threatening consequence is the rise of potassium levels in the bloodstream, a state termed hyperkalemia. Potassium is a mineral that is normally tightly controlled by the kidneys because of its direct influence on heart muscle function. As potassium concentrations become dangerously high, the electrical signals that regulate the heartbeat are disrupted. This severe electrolyte imbalance often results in fatal cardiac arrhythmias, causing cardiac arrest.
The third major complication involves the body’s inability to excrete water, leading to severe fluid overload. Excess fluid accumulates in the tissues, causing pronounced swelling in the extremities and face, known as peripheral edema. Fluid also backs up into the lungs, creating a condition called pulmonary edema, which severely impairs the body’s ability to absorb oxygen. This pulmonary congestion places immense strain on the heart, further contributing to system failure.
The Expected Timeline of Decline and Symptoms
The time a person can live after discontinuing dialysis varies, largely depending on their residual kidney function and overall health condition at the time of cessation. For most individuals with no remaining kidney function, survival generally ranges from a few days to approximately two weeks. However, those who still produce a small amount of urine or have fewer underlying health issues may survive for a few weeks longer.
Initial Days
In the initial days following the last treatment, the first noticeable symptoms are often generalized fatigue and weakness, along with a loss of appetite and increasing drowsiness. Patients may also begin to experience nausea and vomiting as uremic toxins irritate the digestive system. Swelling from fluid retention also becomes more apparent in the legs, ankles, and hands during this early period.
Mid-Stage Progression
As the uremia progresses, the neurological symptoms become more pronounced. Patients often exhibit significant confusion, cognitive decline, and restlessness, which can be distressing for family members. The fluid overload intensifies, leading to shortness of breath, or dyspnea, as the lungs become congested. This difficulty in breathing can be one of the most uncomfortable symptoms experienced during this phase.
Final Days
In the final days, the body begins to shut down, and symptoms become more severe. The patient typically spends most of their time asleep, becoming increasingly difficult to awaken. Untreated uremia can precipitate muscle twitching, tremors, and in some cases, seizures. Death is commonly caused by the severe electrolyte disturbance of hyperkalemia leading to cardiac arrest, or by overwhelming pulmonary congestion and respiratory failure.
Palliative Care and Patient Autonomy
The decision to stop dialysis is a deeply personal choice that falls under the legal and ethical right of patient autonomy to refuse medical treatment. When a patient decides to discontinue a life-sustaining therapy, it shifts the focus of care entirely from prolonging life to ensuring comfort and maximizing the quality of the remaining time. This transition is managed through a comprehensive approach known as palliative care or hospice care.
Palliative care teams specialize in addressing the symptom burden associated with end-stage kidney failure, even after dialysis stops. They work to manage physical symptoms such as pain, nausea, anxiety, and the shortness of breath caused by fluid accumulation. Medications are carefully adjusted to account for the lack of kidney function, ensuring that drugs clear the body appropriately without causing further toxicity.
The goal of hospice is to provide a peaceful and dignified experience, affirming that stopping dialysis does not mean stopping care. Support is also extended to the patient’s family, offering grief counseling and emotional resources as they navigate the withdrawal process. This holistic support system ensures that the patient’s wishes are respected and that all symptoms are managed to promote comfort until the end.